Low back pain

Back pain - low

Low back pain is a common problem. About 60 to 80% of the adult U.S. population has low back pain, and it is the second most common reason people go to the doctor. Low back problems affect the spine's flexibility, stability, and strength, which can cause pain, discomfort, and stiffness.

Back pain is the leading cause of disability in Americans under 45 years old. Each year 13 million people go to the doctor for chronic back pain. The condition leaves about 2.4 million Americans chronically disabled and another 2.4 million temporarily disabled.

Most back pain can be prevented by keeping your back muscles strong and making sure you practice good mechanics (like lifting heavy objects in a way that will not strain your back).

Signs and Symptoms

Symptoms of low back pain may include:

Tenderness, pain, and stiffness in the lower back

Pain that spreads into the buttocks or legs

Having a hard time standing up or standing in one position for a long time

Discomfort while sitting

Weakness and tired legs while walking

What Causes It?

In most people, the cause of low back pain is unknown. It may be caused by an injury, strain from lifting, twisting, or bending. In rare cases, low back pain can be a sign of a more serious condition, such as an infection, a rheumatic or arthritic condition, or a tumor.

A ruptured or bulging disk, the strong, spongy, gel-filled cushions that lie between each vertebra, and compression fractures of the vertebra, caused by osteoporosis, can also cause low back pain. Arthritis can cause the space around the spinal cord to narrow (called spinal stenosis), leading to pain.

Risk factors for back pain include age, family history of low back pain, smoking, being overweight, being female, being anxious or depressed, and either doing physical work or sedentary work.

What to Expect at Your Provider's Office

Often your doctor will be able to diagnose your back pain with a physical exam. Your doctor will ask you to stand, sit, and move. Your doctor will check your reflexes and perhaps your response to touch, slight heat, or a pinprick. Depending on what your doctor finds, other tests may include an x-ray, a magnetic resonance imaging (MRI) scan, a bone scan, and computed tomography (CT) scan.

Treatment

In many cases, back pain improves with self care. You should see your doctor if your pain does not get better within 72 hours. You can lower your risk of back problems by exercising, maintaining a healthy weight, and practicing good posture. Learning to bend and lift properly, sleeping on a firm mattress, sitting in supportive chairs, and wearing low-heeled shoes are other important factors. Although you may need to rest your back for a little while, staying in bed for several days tends to make back pain worse.

For long-term back pain, your doctor may recommend stronger medications, physical therapy, or surgery. Most people will not need surgery for back pain.

Medications used to treat low back pain include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve), muscle relaxants, such as carisoprodol (Soma), and steroids, such as prednisone. Your doctor may prescribe opiates, such as hydrocodone (Lortab, Vicodin) for short-term use. An injection of a corticosteroid (cortisone shot) may also help decrease inflammation.

Complementary and Alternative Therapies

Alternative therapies can help ease muscle tension, correct posture, relieve pain, and prevent long-term back problems by improving muscle strength and joint stability. Many people find pain relief by using hot and cold packs on the sore area. Special exercises, such as ones designed for your specific problem by a physical therapist, can help strengthen your core abdominal muscles and your back muscles, reducing pain and making your back stronger.

Nutrition and Dietary Supplements

There is no special diet for back pain, but you can help keep your body in good shape by eating a healthy diet with lots of fruits, vegetables, and whole grains. Choose foods that are low in saturated fat and sugar. Drink plenty of water.

Foods that are high in antioxidants (such as green leafy vegetables and berries) may help fight inflammation.

Omega-3 fatty acids, such as flaxseed and fish oils, to help reduce inflammation. Omega-3 fatty acids can increase the risk of bleeding and potentially interfere with blood-thinning medications such as warfarin (Coumadin) and aspirin.

Methylsulfonylmethane (MSM), to help prevent joint and connective tissue breakdown. In some studies, MSM has been shown to help relieve arthritis pain.

Bromelain. This enzyme that comes from pineapples reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without first talking to their health care provider. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Bromelain may interact with some antibiotic medications.

Turmeric (Curcuma longa) standardized extract, for pain and inflammation. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood-thinning medication. Ask your doctor before taking turmeric.

Devil's claw (Harpagophytum procumbens) standardized extract. Devil's claw has been used traditionally to relieve pain. One study found that more than 50% of people with osteoarthritis of the knee or hip, or low back pain, who took devil's claw reported less pain and better mobility after 8 weeks. Devil's claw may increase the risk of bleeding and interact with diabetes medications, as well as potentially several types of medications. Tell your health care provider before taking it if you also take blood-thinning medication, or if you have diabetes. Devil's claw can affect the heart, and may not be right for people with certain heart problems. It can also potentially be problematic for people with gallstones.

Willow bark (Salix alba) standardized extract, to relieve pain. Willow acts similar to aspirin. DO NOT take white willow if you are also taking aspirin or blood-thinning medications. Check with your provider if you are allergic to aspirin or salicylates before taking white willow. DO NOT give Willow to children under the age of 18.

Capsaicin (Capsicum frutescens) cream, applied to the skin (topically). Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it may temporarily reduce amounts of "Substance P," a chemical that contributes to inflammation and pain. One found a topical capsaicin cream relieved pain better than placebo in 320 people with low back pain. Pain reduction generally starts 3 to 7 days after applying the capsaicin cream to the skin. DO NOT use internally.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following treatments to relieve low back pain based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. Repeat this procedure for 3 consecutive days.

Acupuncture

Research suggests that acupuncture may be effective for low back pain. In addition, acupuncturists frequently report success in treating low back pain, and the National Institutes of Health recommend acupuncture as a reasonable treatment option. An acupuncturist may use a comprehensive approach, including specialized massage, warming herbal oils, and patient education.

Treating low back pain with acupuncture can be complex because many meridians (including the kidney, bladder, liver, and gallbladder) affect this area of the body. Treatment of the painful areas and related sore points is often done as well, with needles or moxibustion (burning the herb mugwort over specific acupuncture points).

A study of 1,162 people with a history of chronic low back pain found that at 6 months of acupuncture treatments relieved low back pain, almost twice as much as from conventional therapy. People had 10, 30-minute acupuncture sessions, generally 2 sessions per week.

Chiropractic

According to a comprehensive review conducted by the Agency for Healthcare Research and Quality, spinal manipulation and NSAIDs are the 2 most effective treatments for acute low back pain. Of these, only spinal manipulation relieves pain and restores function. Spinal manipulation also appears to be effective for chronic low back pain, but the evidence is less conclusive. Some studies even suggest that spinal manipulation is no more effective than other recommended therapies.

Massage

Massage may help treat and prevent short and long-term back problems.

Yoga and Tai Chi

Evidence suggests that the mind-body practices of yoga and tai chi offer significant relief of the symptoms of low back pain. In one study of 300 people with low back pain, those who participated in a 12-week yoga program experienced greater improvements in back function than did usual care. Gigong appears to be similarly effective.

Special Considerations

Chronic low back problems can interfere with everyday activities, sleep, and concentration. Severe symptoms may affect mood and sexuality. Chronic pain is also associated with depression, which can in turn make chronic pain worse.

Chou R, Huffman LH. American Pain Society, American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505-14.

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